Psychotherapy is one of the most important parts of addiction treatment. At least half of people with substance use disorders have a co-occurring mental health issue, and many believe the figure is closer to 80 percent. Issues such as depression, anxiety, bipolar disorder, personality disorders, ADHD, OCD, PTSD, schizophrenia, and autism spectrum disorders significantly increase your risk of developing a substance use disorder. These co-occurring issues must be addressed to give you the best chance of a successful recovery from addiction. Many people are not even aware they have a co-occurring disorder; they may just know they feel bad and drugs or alcohol make them feel better. Discovering and treating underlying mental health issues is crucial to addiction recovery. Although you don’t have to know anything in particular before entering therapy, there are a few things to keep in mind that will help you get the most out of your time with your therapist.

Think of therapy as a collaboration.

Therapy is not like bringing your car to the mechanic; your therapist can’t just fix your mind. It’s not even like going to the doctor, to whom you describe your symptoms and receive feedback. Therapy is a much more collaborative process. Your therapist only knows what you share. Your therapist is an expert on human behavior, but they don’t know your history, what bothers you, and what you want to accomplish. For a therapeutic relationship to work, you have to do your part. Think of your therapist as an expert consultant who can help you live a better life.

Set goals for therapy.

If you’re in therapy as part of addiction treatment, your general goal will clearly be staying sober. However, there are many other efforts that might support that goal and give you some indication whether you’re making progress. Try to identify these goals- for example, you might want to feel less anxious in social situations or you might want to have a healthier relationship with your parents. You don’t have to choose one goal to focus on, but making a dream board, or penning gratitude lists can serve as tools to measure your progress. Chronicling movement towards your goals tells you whether or not therapy is working, and seeing your life improve gives you extra motivation to stay engaged in the process.

Speak freely.

Being open is crucial for therapy to work. You have to be honest about what you’re thinking and feeling, and sometimes this is a process. Some things are hard to talk about and you have to work up to it gradually. Typically, your therapist won’t push you to talk about something before you’re ready. However, if there’s something you don’t want to talk about yet, it’s better to say so than to lie.

Therapy is also different from normal conversation in that it’s fine to say whatever happens to pop into your head. Tangents, random associations, and seemingly irrelevant thoughts can sometimes be helpful. You don’t have to know exactly what you want to say before you try to say it. Sometimes our most powerful emotions are the hardest to articulate.

Your therapist is one of the safest people to share your innermost thoughts with, as they are required by law to keep anything you say private. The only exceptions are typically if you plan to harm yourself, others or if there is a child in danger. Another benefit of the confidentiality between a therapist and a patient is a lack of pre-existing bias- you get to tell your story, in your voice.

Do your homework.

Therapy isn’t just about talking to your therapist for 50 minutes once or twice a week. If you really want to get the most out of therapy, you have to make a conscious effort to apply what you talked about. Sometimes this will be open-ended. For example, maybe you’ll realize you’re overly sensitive to criticism so you make a special effort to be aware of that when people give you feedback in your day-to-day life. Sometimes your therapist will specifically give you homework, perhaps something like expressing appreciation to someone important to you or writing about episodes of anxiety. Following through on these assignments consolidates what you’ve learned and helps you apply it to your real life. Even if you don’t get homework, it’s a good idea to keep a therapy journal and write down what you talked about and how you felt about it.

Ask questions.

Therapy is your time and if there’s anything you don’t understand or are curious about, just ask. It doesn’t matter if it’s something about therapy, psychology, your therapist, or your own situation. Any information you get will help you orient yourself. Knowing why you’re doing something can also be motivating.

Use therapy for practice.

Therapy isn’t just a meta-exercise in understanding your own psychological issues; it’s also an opportunity to practice new skills and try things out. Although therapy is a special kind of relationship, at a fundamental level, it’s just two people talking. It’s a safe space to work on some of the things you’ve been talking about. You can practice eye contact, asking questions, setting boundaries, or anything that gives you trouble in everyday interactions.

Enforce boundaries around therapy.

Although your therapist must keep your sessions confidential, you can talk about whatever you want. However, it’s often a good idea to limit what you say to others about your sessions. For one thing, you have no expectation of privacy once you tell someone who’s not your therapist. Since you often talk about deeply personal stuff in therapy, you might not want it floating around. Second, everyone has an opinion. You might end up getting all kinds of unsolicited advice and some of it might undermine your therapy work. If you do talk about therapy with others, make sure it’s with good reason, to people you trust.

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